Patient Compliance in Dialysis
Patient Compliance in Dialysis
Physicians have committed themselves to treat for the well-being and good of their patients. However, there are usually clashing requirements and pressures which have legal, medical, and ethical implications that impact the physician’s capability to give the needed care. Although most patients undergoing dialysis work with the specialist and dialysis institution to get quality care, some tend to be noncompliant, aggressive, and abusive (Ripley, 2019). Hence, physicians need develop a suitable plan that would improve how they attend to the patients. The plan is necessary because contrary to many specialties, dialysis care offers additional constraints as a result of regular engagement with the patient, restricted treatment options, and morbid effects of lack of care. Patients also have to deal with a number of challenges that could lead them to be noncompliant with the dialysis process. The procedure often require 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, the treatment subjects them to financial, emotional, and medical constraints. These hindrances, especially in 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 other approaches to improve or achieve compliance, and it is up 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
- Improving lab outcomes in dialysis.
- Educate and enlighten dialysis patients 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.
- 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 normal.
- 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.
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 either 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 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. Serious scenarios may result in the patient being moved away from the unit. If wholly on the basis of 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 category of the continuum, it is the aggressive non-complaint 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 extreme end have threatened physicians with deadly weapons such as guns and knives and there have been incidences of patients shooting at a staff at the facility or within its premises.
Certainly, suggestions for behavior modification initiatives, counseling, and substance abuse programs may be of significant assistance. Some affected patients even with these interventions have continued to 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). A significant number of institutions that deal with patients showing chronic signs have procedures and policies for avoiding such patients and some renal institutions have created recommendations and procedures (Ripley, 2019). These encompass measures to dismiss the person receiving treatment once trials at written warnings and behavioral approaches have failed to give anticipated 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 or for the patient’s well-being or that of 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 rather unclear. New Federal directives offer additional guidelines concerning unintentional discharge of a dialysis patient. The new directives 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, ort 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 provision is 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.
Nevertheless, involuntary transfer and discharge should happen in accordance with Conditions for Coverage for ESRD Facilities. The Final Rule requires that facility must notify all patients of their rights encompassing the regulations and expectations of the organization concerning patient behavior and roles, the external and internal grievance directives and the transfer and discharge policies both for involuntary and routine purposes (Federal Register, 2021). Besides, the regulating body must ensure that everyone adheres to the procedures and policies. The medical director has an obligation to ensure that the patient is not released from 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 have the obligation to reassess and document ongoing issues and come up with possible ways for mitigating the challenge (Federal Register, 2021). In addition, the Final Rule directs that a physician provides a patient with and the End-Stage Renal Disease Network that operates locally with a 30-day prior notice of premediated discharge. Patients, on the other hand, 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 (Federal Register, 2021). The guideline further encourages physicians to contact another institution, attempt to relocate the client there, and record the effort. The physician should go further and inform the state survey agency of the decision to relocate or discharge the patient (Federal Register, 2021). 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.
Researchers have explored the effectiveness of other various intervening techniques used to improve patient compliance and present their findings in a bid to help both practitioners and patients to adhere to the process. Evidence suggest that consuming a light meal is recommended before the 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 to 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 also 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 is a major concern for patients undergoing dialysis that could result in receiving improper treatment that could worsen their case. Therefore, checking on lab outcomes regularly helps to ensure the results are normal offers a suitable opportunity to make dialysis treatment more appealing to the patient (Federal Register, 2021). Other than checking on the results regularly to ensure that no fault occurs, frequently checking the lab outcomes helps to identify whether the intervention has a positive impact on mitigating the condition (Federal Register, 2021). A patient gains the interest and patient to undergo dialysis when the intervening specialist give regular reports of their progress backed with lab findings (Federal Register, 2021). A critical aspect is for the physician to know how to document the data and how to present the information he/she gets from the lab tests. In this case, a practitioner may have to gain certain communication skills that would improve how they interact with the patient, especially when relaying the interpretations of the lab tests.
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 the weight of a patient each time they present themselves to the clinic. Kim et al. (2021) inform that one of the most essential objectives of physicians who handle patients with chronic renal failure is to acquire information on dry body weight with the objective of maintaining or normalizing blood pressure and averting further cardiovascular-related ailments. The practitioner should inform the patient that they must undergo regular weight checkup to avert fluid gain that is sparked by a drop in urine flow and a normal to escalated consumption of dietary fluids. Hence, a physician is able to determine fluid gain by the weight increase between treatments, which is the reason 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 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 compel the kidneys to put more effort into filtering wastes beyond the recommended level. Over time, this added task escalate the threat for kidney disease (Kim et al., 2021). Therefore, taking measures that promote the patient’s well-being and explaining to them 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 important to stick to the treatment despite the challenges associated with the procedure. The education should focus on various aspects, including explaining the significance of adhering to 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 treatment or respond harshly. The opposition some patients show towards the treatment subject them to more harm considering the nature of their illness that require specialized attention. The literature review restores confidence that those who show resistance towards treatment have hope because physicians can choose to follow a particular structure that help 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. Being able to know why the patient defy the treatment procedure presents a better chance to mitigate more effectively. Otherwise, disregarding the problem or terming it as one that requires little attention could worsen the situation and put more patients at more risk.
The most appropriate method to attain the stated objectives is to adopt a suitable research design that would navigate the research in the most appropriate manner. A systematic literature review identifies, chooses and analytically assesses research with the purpose of reacting to visibly created research questions (Okoli & Schabram, 2015). The research technique is fitting for this circumstance because it aims at identifying as much appropriate information on the outlined research questions as possible and because it utilizes clear methods to find out what can positively be expressed or described on the basis of the subject under study (Okoli & Schabram, 2015). The research design uses clear and utilizes transparent and systematic methods to summarize existing evidence without or with insignificant 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 foremost 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 and the researcher should be in a position to access relevant materials or sources that give needed data. The next stage would be to search and evaluate the works that will largely 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 important 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 that talk 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 feed key words such as dialysis and compliance, and phrases such as adult hemodialysis patient noncompliance, chronic kidney diseases, and hemodialysis patient noncompliance among others.
The next stage would be to scrutinize and fuse the generated data using the most apposite method. The most apt data analysis method for this research is the descriptive data analysis routine that makes it possible to describe, exemplify and recap data in a right manner 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 with the objective of recognizing information that help to gain some consciousness about the research questions (Okoli & Schabram, 2015). The descriptive data analysis method is one of the most 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 approach is also suitable 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 associated with the data descriptive technique to avoid inconveniences at an advanced stage of the research (Okoli & Schabram, 2015). The evident demerit associated with 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 they have gathered to generalize to other contexts or scenarios. Overall, the descriptive data analysis technique is an appropriate technique for this research despite the limiting factors.
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 there are a number of options that 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 it is possible for a physician to devise or customize a plan that they feel would engage patients and show 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 to facilitate the achievement of the research goal and objectives it would be necessary to conduct a 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 a good position to achieve the best results. Consequently, it is imperative to spend some time to learn how the approach work from different sources and researchers who have used a similar approach in their studies. Effective application of the technique would help to get the needed and right data that make it possible to respond to the issues under investigation.
Federal Register. (2021). Medicare program; End-stage renal disease prospective payment system, payment for renal dialysis services furnished to individuals with acute kidney injury, end-stage renal disease quality incentive program, and end-stage renal disease treatment choices model. The Daily Journal of the United States Government, 61874-62026. https://www.federalregister.gov/documents/2021/11/08/2021-23907/medicare-program-end-stage-renal-disease-prospective-payment-system-payment-for-renal-dialysis
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/