Self-Management in Renal Nursing: Analysis of Discrepancies and Long-Term Advantages

This paper analyzes the discrepancies that lead to the fact that most patients are turning to conduct their dialysis in hospitals and satellites and a long-time advantage of a closer alignment between preference and reality, for individual health care and the health system.

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SELF MANAGEMENT IN RENAL NURSING
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Self-Management in Renal Nursing
Ideally, kidney problem has continued to be a common complication to be recorded in the
wide medical discourses. While the prevalence rate of the PRT by age in both Australia and New
Zealand has been cutting across all age groups, the highest prevalence rate has been between age
group 65-74 (Jayasinghe et al., 2018, pp. 2). In this light, there has been a need to address this
issue across all societies by medical practitioners through a procedure called dialysis. It is no
doubt that the estimated cost of rather home-based dialysis modalities is lower than that of
center-based hemodialysis (HD) (Alkatheeri, Blake, Gray, and Jain, 2016, pp. 171). In fact,
according to recent research, home-based dialysis in the United States is estimated to be around
twenty thousand dollars for every patient per year less than that of HD. This paper proposes to
analyze the discrepancies that lead to the fact that most patients are turning to conduct their
dialysis in hospitals and satellites and a long-time advantage of a closer alignment between
preference and reality, for individual health care and the health system.
With no clear evidence of a substantial difference between the two modalities regarding
the survival as well as the overall quality of life, it would be assumed advantageous in case the
proportion of stage 5 chronic kidney disease patients are encouraged on a home managed
therapy. Consequently, home hemodialysis has been considered as an appropriate therapeutic
option for about four decades across the globe and in particular New Zealand and Australia. It is
no coincident that home-based dialysis has been a somewhat existent modality of a renal
replacement therapy since the 1960s while its interest is increasing in the contemporary society
due to its flexibility as well as its benefits (Arzanlo, Fazlzadeh, and Hazrati, 2017, pp. 103). The
advancement in dialysis technology has aided its applicability in recent times allowing it to be
undertaken at the comfort of patient’s homes.

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Analysis of the Discrepancies May Occur (Why Patients Now Prefer Hospital And Satellite
Dialysis Rather Than Home Dialysis)
Primarily, home dialysis carries with it a lot of advantages in the field of medicine for
patients with kidney failure. For instance, one significant advantage of home dialysis is the fact
that it only requires a rather dialysis session in three times every week where there is no need to
go to the medical clinic for dialysis (Bluchel, Wang, and Tan, 2016). Survival of patients has
been tipped to be among the reason of consideration of the kind of modernity when treating
kidney complication. In this case, various studies have increased survival as a rationale when
deciding dialysis. As a result, many patients have considered taking their dialysis in hospital
clinics rather than at home in recent times particularly in Australia. According to research, the
survival rate of dialysis patients who are treated at home is longer compared to those going to
clinics (Foote, Kotwal, Gallagher, Cass, Brown, and Jardine, 2016). However, recent observation
has indicated a rather short-term survival rate with Peritoneal Dialysis (PD) while there is a long-
term survival rate that is comparable to transplantation with a somewhat nocturnal home HD
involving a deceased donor. In fact, there has been a decline in home dialysis from 2012 to 2016,
a period that recorded a decline from 29% to 28% within that period (Jayasinghe et al., 2018, pp.
4).
While various literature has showcased the aspect of dialysis at home to be the most
highly regarded by patients due to its flexibility as well as its convenience, most developing
countries do not honor this assumption especially in the contemporary society. Consequently,
most people prefer dialysis at the hospital since they have a different perspective regarding self-
Cannulation as well as the provision of staff support especially during weekends and overnights
(Jin, Yun, Lee, Han, Kim, and Park, 2016, pp. 204). However, some researches suggest that

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those patients who have undergone multifaceted education for a pre-dialysis had a perception
that that undertaking dialysis at home one would have control as well as advantages and,
therefore, chose self-dialysis. However, there has been an apparent divergence from the
perspective of satellite and hospital dialysis due to the desires that caregivers tend to have
towards dialyzing their patients at home as well as their own need for respite. According to
research conducted regarding self-management in renal nursing, by the end of 2016 there was a
higher number of patient receiving dialysis at home in New Zealand than in Australia.
Even though most caregivers are in preference of home dialysis, a number of them feel
there is a need for respite caregivers for a rather long-term because they believe that they are
more sustainable compared to treatment at the hospital. Another important consideration that has
played a part in changing trend on whether to prefer home dialysis or hospital and satellite
dialysis is the aspect of caregiver burden (Nguyen, Shugart, Lines, Shah, Edwards, Pollock,
Sievert, and Patel, 2017). Consequently, Australian evidence based research on HD suggest that
patients may resolve on requesting a permanent shift to satellite HD with the aim of giving
involved families respite.
Long-Term Advantages, Of a Closer Alignment between Preference and Reality, For
Individual Health Care and the Health System
In essence, strategic planning is no doubt a valid as well as a useful tool in guiding any
type of a firm including a health care system across the globe. In this light, a unit size of a health
care system is the basic unit through which strategic planning is valid. Preference and reality
would be necessary to a particular patient in that he or she would have time to figure out which
modality to approach to in case of dialysis in a specific medical organization (Mitzner, 2016, pp.
21). It is therefore clear that the process of preference and reality is a holistic procedure that

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often tries to bring closer the aspect of short-term, medium as well as long-term particulars
giving a particular healthcare organization time to focus on the overall relevant as well a long-
lasting transformation for the future of a patient and the entire healthcare system.
Primarily, there are various reasons why a particular healthcare organization is often
encouraged to apply the aspect of preference and reality when considering the future their
patients and in particular those that are under dialysis. One clear advantage that a health care
system is that the system is likely to increase patients confidence in a specific organization of
healthcare. This is mainly because in case a form applies this aspect then patients are going to be
informed about their rights and they would, therefore, prefer attending a treatment in a hospital
that takes the effort of enlightening them rather than those that blatantly assume the rights of
their patients (Morton, Tong, Webster, Snelling, and Howard, 2011). In essence, this is likely to
have a long-term effect on an organization as well as its patients due to the loyalty effect.
Furthermore, strategic planning is the overall process that primarily aims at bringing the
entire future of a firm closer by allowing people to study as well as conduct various simulations
of the future intentions of a particular healthcare organization in Australia (Son, Mannoia,
Herrera, Chizari, Hagdoost, and Molkara, 2016). In this process, there is a chance that previously
hidden opportunities or even threats can be revealed therefore creating them with various options
to act on such uncertainties as early as possible. In this light, this process is likely to provide a
clear strategic framework with multiple criteria of handling day-to-day activities in a hospital
especially the decision making on how to conduct treatment with a kidney complication (Lin,
Zhang, Zhang, and Lin, 2016, pp. 121). Moreover, this process is likely to create value in
personal judgment which facilitates as well as simplifies the overall managerial decision making
in the long run (Xie, Ling, and Lo, Baxter Healthcare and Baxter International Inc, 2017). As a

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matter of fact, the creation of an instead [reference as well as reality strategy encourages the
overall participation and commitment of the entire healthcare organization especially in the
process of achieving its planned results and therefore becoming a significant part in the cohesion
of a firm and the overall treatment process of patients with kidney failures. Finally, it is no doubt
that a particular organization especially a health care system that tends to apply excellent
strategic planning and therefore uses it in a somewhat consistent manner is likely to offer a
serious as well as credible corporate reputation to its clients who are patients in this matter.
Personal Reflection as a Nephrology Nurse
I would be highly tempted to put the entire survival on the top list when treating an
individual with kidney failure in an organization. I remember some few years ago I was lucky to
get a unique chance where I worked with a particular hospital in Western Sydney where I got an
array of experience regarding dialysis both at home and even at the hospital and satellite stations.
In essence, I must say that I had to undertake rather one-year coursework before I was awarded
that medical experience in my career. I remember all enthusiasm that I had in my starch white
uniform while pressed in my white sneakers ready to work and explore the unknowns. Although
I had had a family member with kidney complication before, this was a new challenge on its
own, and I took it seriously from the start. I was ready to help patients get the best medication
whenever I was needed. My role in this capacity was a nephrology nurse something that I was
prepared to explore what it entailed in real practice.
While at the hospital, I had to learn various practices, all that I consider has been the
basis of my career. For instance, I learned how to give care to patients who were suffering from
kidney complication or even other comorbid conditions that were considered to have a direct
impact on the patient’s kidney. Some of the terms I came across while in the hospital included;

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heart disease, bone diseases, hypertension as well as diabetes, and infectious diseases. Since
these conditions cuts across all ages, I was supposed to deliver care to both children as well as
old adults in such a wide range of setting.
Every day working as a nephrology nurse seemed different in this unknown subtle. Since
I was just fresh from college, I had no authority to assess a patient’s condition directly, but I had
to do it under a specialist I was assigned to. Apparently, through the supervision of a specialist
whom I do not remember her name, I was in a position to assess patient’s condition, identify the
overall risk factors, train various patients on initiating dialysis at home, monitor patients
especially during dialysis, and start dialysis as well as providing car following a successful renal
transplant process. However, I was no in a position to coordinate a rather direct, introducing a
unique treatment method to patients and families, or even intervene in the process of stopping
hospitalization process as well as organizing dialysis staff. I must say that I learned a lot of
things and in particular the preference that patients and caregivers mostly consider when
deciding the type of dialysis modalities to undertake. In the station that I was in, there was a
definite turn out of patients who preferred to have their dialysis process in the hospital and the
satellite stations that we often set out.
Nonetheless, some people considered the flexibility of home dialysis and would take the
challenge of performing cannulation at home rather than having to experience additional charges
such as transpiration cost to go to hospitals. Although I often had a rough and tough schedule
while working as a Nephrology Nurse, I must say that I learned a lot of values that I know would
be beneficial throughout my entire career journey. I learned various tricks that include
cannulation that I would not hesitate practicing when needed be.

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In a nutshell, it is no doubt that the topic surrounding Peritoneal Dialysis (PD) and home
dialysis has been a debated topic for the last couple of decades particularly in Australia and New
Zealand. Home dialysis process has various advantages that some patients consider when
deciding the type of modalities to take. For instance, with home dialysis, patients have the
flexibility at hand and the freedom to do various things on their own in which some people
consider it as a perfect experience. Additionally, there is the aspect of less cost experienced
during home dialysis something that the people in Australia and New Zealand have kept into
consideration for a couple of decades now. However, this trend has been changing with time as
people consider hospital or rather satellite dialysis as the best option. It is no doubt that the
changing trend has arisen thanks to the different perspective that patients have been having
regarding one doing cannulation on their own.

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