Case Study: Nursing Care for End-Stage Renal Disease Patient

This case study details the nursing care provided to a 20-year-old Aboriginal Torres Strait Islander patient named John, diagnosed with end-stage renal disease (ESRD) and admitted to hospice care. The patient, facing a terminal prognosis and expressing a desire to discontinue dialysis, prompted the nurse to employ a holistic approach, including pain management using IQ methods, and social, emotional, and spiritual support. The nurse utilized cognitive behavior therapy (CBT) to address the patient's depression, which was impacting his compliance with treatment. Cultural sensitivity was paramount, with the nurse actively learning about the patient's background, beliefs, and traditions, and providing spiritual therapy rooted in the patient's Christian faith. The case highlights the importance of understanding cultural factors, employing effective communication, and providing comprehensive care to improve the patient's quality of life and mental health within the context of a life-limiting illness.

Running head: END STAGE RENAL DISEASE 1
END STAGE RENAL DISEASE
Student’s Name
Institutional Affiliation

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End-Stage Renal Disease
Hospice care is a type of care that is designed to provide supportive care to the individuals
that are on their final stage of critical illness. The primary focus of hospice care is to enhance
the quality of life and provide comfort for the patient to be able to manage pain. The majority
of the hospice programs are home-based; however, the services can be delivered away from
home in the medical facilities that are freestanding such as nursing homes. On the other hand,
hospice care majorly utilizes a multidisciplinary team approach that may comprise of the
doctor, nurse, clergy, and social workers in the administration of care. The services that may
be provided constitute speech, occupational, and physical therapy. In addition, drugs for pain
management, medical equipment and supplies, counseling, dietary, and bereavement services
may be provided (Kalantar‐Zadeh et al., 2015). On the other hand, hemodialysis is utilized on
the patients who have kidney failure, and the process involves the removal of toxic waste
from the bloodstream. This process can be utilized to increase the life expectancy of the
ESRD patients by improving the quality of life (Weisbord, 2016).
An end-stage renal disease patient (ESRD) was admitted to hospice care, which I was a
nurse. The patient was an Aboriginal Torres Strait Islander (ATSI) and known as John. He
was 20 years of age and had lost hope in the dialysis treatment when the doctor informed him
that he could not survive more than three months. The patient did not want any further
treatment and wanted to go home; however, his life expectancy would be reduced if he
stopped the treatment.
As a nurse who was looking after John, I realized that he was in pain; thus, I had to use IQ
pain control methods. I had to provide social, emotional, and spiritual aid to the patient as
well as diagnosing his symptoms as part of the treatment plan. The patient had more chances
of dying than surviving the dialysis even if he adhered to the medication. Haemodialysis
treatment is a complex process that requires a multidisciplinary team approach since it

END STAGE RENAL DISEASE 3
involves monitoring, control of the fluid and dietary intake of the patient, and maintenance of
the polypharmacological medication regimen.
I utilized cognitive behavior therapy (CBT) to reduce the pain and depression that the
patient was enduring (Hudson, Moss‐Morris, Game, Carroll & Chilcot, 2016). Depression
caused John not to be compliant with the dialysis treatment, which could have declined his
quality of life and shorten his lifespan (Ma & Li, 2016). CBT seemed to be effective since the
patient mood, anxiety, and stress had reduced.
Culture is a broad concept that encompasses race, norms, beliefs, traditions, habits, social,
economic status, and identity (Wilson, 2016). Therefore, as a nurse, I had to use proper
communication skills to make the patient be more understanding. The active listening skill
was core in this aspect since I listened attentively to the patient's issues and summarised the
key points to enhance proper medication. The proper interpersonal skills enhanced trust and
patient-nurse relationship, making John be more open to me. I had the will to learn the
patient’s cultural background to deliver proper care (Li, 2017). The patient being an
Aboriginal Torres Strait Islander I learned that majority of the people in their region died at a
younger age due to poor medical services. The people in the region experienced a great
burden of chronic infections, which led to a high mortality rate. Most of the health conditions
that the people had were genetically inherited. In addition, people practiced unique cultures,
beliefs, languages, and knowledge systems. They had traditional knowledge in the
management of natural resources. The people were agriculturalists who mainly depended on
gathering and hunting as a source of living. Thus, they basically relied on traditional foods.
Despite the Aboriginal Torres Strait Islander people having their traditions and beliefs,
they were Christians. Their culture enabled them to understand and adopt the new religion;
thus, they did not have to abandon their traditional beliefs.

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On the other hand, according to the patient, he had lost hope since he came from a humble
background; the family members were toiling to raise funds for the dialysis. He thought that
if he was going to die in a three month period, then there was no need for dialysis. This is
because dialysis is costly, and his family will be left with no funds to take care of themselves
when he is dead.
I had to offer spiritual therapy, having understood the culture and beliefs of the patient.
Spiritual therapy is a form of counseling that tries to heal the mind and soul of the patient
through a proper understanding of his beliefs. The patient being spiritually attached to
Christianity, I had to explore his spiritual willingness to enhance his quality of life and mental
health (Koenig, Pearce, Nelson & Erkanli, 2016). I reconnected the patient with the higher
power for him to find purpose and balance of life. Spiritual therapy enabled him to
understand the importance of life and the existence of miracles (Lucchetti, Peres, Vallada &
Lucchetti, 2015). Thus I emphasized that there could be a possibility that the almighty God
could save his life through a miracle. I even referred to a scripture in the bible that said "faith
without action is dead," which meant that his first phase of healing is through self -belief.
The second phase of healing will be through being compliant with the dialysis, which may
save his life and enhance his life span.
In conclusion, I was able to offer a proper spiritual therapy to the patient due to my
personal beliefs as Christian. Thus my personal interaction with the patient was easy since I
had background knowledge of the Christian religion. It facilitated and enhanced trust with the
patient since I did not insult his cultural or spiritual beliefs. I provided moral and ethical
guidelines that gave him comfort and purpose to live. I employed a spiritual strategy of being
sensitive and understanding to the patient's desires to deliver quality medical care.

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References
Hudson, J. L., Moss‐Morris, R., Game, D., Carroll, A., & Chilcot, J. (2016). Improving
Distress in Dialysis (iDiD): A tailored CBT self‐management treatment for patients
undergoing dialysis. Journal of renal care, 42(4), 223-238.
Kalantar‐Zadeh, K., Tortorici, A. R., Chen, J. L., Kamgar, M., Lau, W. L., Moradi, H., ... &
Kovesdy, C. P. (2015, March). Dietary restrictions in dialysis patients: is there anything
left to eat?. In Seminars in dialysis (Vol. 28, No. 2, pp. 159-168).
Koenig, H. G., Pearce, M. J., Nelson, B., & Erkanli, A. (2016). Effects on daily spiritual
experiences of religious versus conventional cognitive behavioral therapy for
depression. Journal of religion and health, 55(5), 1763-1777.
Li, J. L. (2017). Cultural barriers lead to inequitable healthcare access for aboriginal
Australians and Torres Strait Islanders. Chinese Nursing Research, 4(4), 207-210.
Lucchetti, A. L. G., Peres, M. F. P., Vallada, H. P., & Lucchetti, G. (2015). Spiritual
treatment for depression in Brazil: an experience from Spiritism. EXPLORE, 11(5), 377-
386.
Ma, T. K. W., & Li, P. K. T. (2016). Depression in dialysis patients. Nephrology, 21(8), 639-
646.
Weisbord, S. D. (2016, March). Patient‐centered dialysis care: Depression, pain, and quality
of life. In Seminars in dialysis (Vol. 29, No. 2, pp. 158-164).
Wilson, C. S. (2016). Cultural learning for Aboriginal and Torres Strait Islander children and
young people: Indigenous knowledges and perspectives in New South Wales schools.