Evidence-Based Nursing Report: Renal System and Haemodialysis

This nursing report delves into the critical aspects of evidence-based practice within the context of renal systems and haemodialysis. It begins by highlighting the prevalence and impact of chronic kidney diseases, emphasizing the need for quality care and cost-effectiveness. The report then explores the application of PICOT analysis to formulate a research question focused on improving the quality of life for elderly patients with end-stage renal disease (ESRD) undergoing haemodialysis. It examines various factors affecting the quality of life, including environmental, genetic, psychological, and emotional stresses, and discusses the role of telehealth in enhancing care. The report further analyzes the evidence, comparing the findings with clinical practices and identifying barriers to implementing evidence-based practices, such as time constraints, lack of knowledge, and inadequate support. Strategies for overcoming these barriers, including structured timelines, the development of evidence-based guidelines, and the use of mixed research methods, are also discussed. Overall, the report underscores the importance of a multidisciplinary approach and the need for continuous improvement in the quality of care for patients with nephrological disorders.

Running head: NURSING
TOPIC: NURSING
Name of the Student:
Name of the University:
Author Note:

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Task 1:
The following essay highlights the importance of evidence based practice in the
practice area pertaining to renal systems or haemodialysis is. Overall prevalence of Chronic
Kidney Diseases (CKD) has been 14% approximately. The prevalence of renal diseases has
increased almost 3.7 in African American 1.5 times among Asian Americans and almost 1.4
times in Native Americans. Moreover statistical studies claim that people die more from renal
diseases and haemolysis cases than prostrate or breast cancer (Information et al. 2019). The
basic keys for the provision of care involve equity, quality as well as the cost of the
healthcare provided. According to Tam-Tham and Thomas (2016), dialysis although a
pragmatic solution often requires more care related to hospice care. Systematic reviews on
patients suffering from haemodialysis or renal disorders reveal that conservative management
is required in such cases which implement programs for proving primary care for patients
suffering from advanced renal diseases. Although there is a lack of proper implementation of
all the components necessary for the proper comprehensive program for management,
improvements have occurred in many cases. Thereby from the studies it is evident that the
ever-increasing cases of people suffering from renal diseases and lack of proper provision of
care makes it the pivotal branch of practice for conducting evidence based research.
Task 2:
PICOT analysis is a term frequently used in nursing practices which is an acronym for
the terms comprising of population followed by intervention, comparison as well as the
outcomes and the time required. Proper identification of all the problems focuses on clinical
problems and literature research (Whalane and Suzzane, 2017). Pertaining to the given
situation, population consists of patients suffering from renal diseases, intervention is renal
systems or haemodialysis, comparison is the effectiveness of dialysis with implementation on

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patients suffering from the renal diseases, and outcome is the increase in the quality of life as
well as the time taken for the proper carrying out of the study. The following PICOT study in
relation to the given branch of practice gives rise to the following question
For old age patients suffering from end stage renal diseases (ESRD), does
implementation of processes involving quality of care have a positive effect on their life?
End related haemodialysis has been a growing public health disease over the past few
years .Many efforts have been low quality of life pertaining to health related issues
implemented for increasing the quality of life in patients under haemodialysis for the
treatment of end state renal diseases (ESRD). It has been found that patients under
haemodialysis have often suffered from energy loss, depression and related mental disorders
as well as poor quality of sleep. Moreover such patients have been more vulnerable to
mortality rates with increased risks and renal diseases have been shown to be independent
predictor showing poor outcomes. Thus it has been concluded that the presence of and
intensity of UP might worsen the quality of life, wellbeing and the implied depressive
symptoms in patients with ESRD (Su Sel et al. 2014).
In studies conducted foe assessing the factors involved for quality of life and the
determination need for further assessment, factors affecting the quality of life generally are
environmental, genetic, psychological, stress co-morbidities and emotional stresses. Findings
have also suggested that low scores on the quality of life have been directly related to higher
risks of hospitalization and death alongside increased serum levels of the patients (Joshi
2014).
According to Lunney (2018), a systemic literature for assessment of quality of care
on patients with ESRD undergoing haemodialysis, the evaluation of care has improved with
telehealth The model of telehealth has assessed knowledge and skills, improved the quality

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of documentation and included facilities like catheter exit site assessment as well as
monitoring the accuracy of dialysis. There also has been a scope design and outcomes for the
intervention of ESRD patients.
Task 3:
From the articles discussed above, it can be understood that various processes have
been implemented over the few years for increasing the quality of care given to old patients
suffering from end stage renal diseases undergoing haemodialysis as the principle clinical
method of implementation. Uremic pruritus has been a diseases associated with the
symptoms of renal failure and has often found to be prevalent with patients suffering from
end stage diseases pertaining to the renal system undergoing haemodialysis. There has been a
positive correlation of such diseases with the symptoms pertaining to various mental ailments
like depression. According to the author there is a significant decreases on the quality of life
as statistically the rate have been found to be much lower along symptoms like depression,
isolation, poor patterns of sleeping. Data have been collected though manual questionnaire
and the responses recorded. Hence the quality of care is reduced and such disease often have
a negative effect on the wellbeing as the parameters for quality control are inefficient to
enhance a better life for patients. These findings and observations have been supported by
Joshi who have stated that there are various factors supporting the low quality care which is
given to patients having ESRD inclusive of environmental, genetic emotional stress. Further
objective as well as subjective studies have been carried out for implementing the
observations affecting patients. Objective measures have been successful in detecting the
various effects of treatment, for an instance the numbers of days dialysis has been conducted
on the patients Subjective comparisons are inclusive of various emotions like satisfaction,
happiness, religious beliefs, as well as spiritual effects. Both the types of information are
necessary for completion of the quality of the care provided and enhance the interpretation of

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the data collected. According to the studies implemented, quality has significantly improved
especially for haemodialysis as compared to other method of dialysis like peritoneal.
However, it has been observed that the care inclusive of higher quality is better for patients
who are treated at home especially old people who require care at their own environments.
The author has even claimed apart from the following suggestions that culture also plays an
important role in the proper shaping of qualitative care patients. Thus, from these articles, it is
evident that there has been a substantial improvement in the methodologies adopted for
providing a proper implementation of quality of care given to patients suffering from disease
pertaining to nephrological disorders, specifically end state neural disorders. However, it is a
multidisciplinary approach and patients still suffer from mental ailments like depression,
isolation, sleep disorders so further improvisations needed to made for proper implementation
of the issues pertaining to the given renal diseases. Thus there is still a lack of the sources
which should be given for enhancing the present situation according to the authors which is
often having a negative impact on health. A huge population of Canada and America has
been suffering from end stage renal disorders. Haemodialysis or peritoneal dialysis is one of
the most common methods of providing relief in form of clinical methods implied. Telehealth
is also known as telemedicine where services involving health care are delivered exclusively
through various technology. Various formats of telehealth delivery include clinician-clinician
or patient-clinician as well a patient to mobile health. The author has explored this
contemporary method of providing quality care to the patients especially suffering from
nephrological disorders. The most important utility of telehealth has been provision of care to
patient especially for the benefit of elder citizens. Thus is can be beneficial to patients for the
treatment at homes. This article can be considered as a high evidence based research articles
as it clearly gives systemic literature following a properly specified protocol. Moreover,
cohort studies as well as randomised clinical trial have been done including patients having

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ESRD with dialysis. The studies have encompassed various issues like the clinical outcomes,
surrogated measurements or patient reported outcomes as well. The studies have been
successful in their findings about telehealth being effective in provision of quality care.
Further controlled trails have compared the various elements and studies which is much
needed. Telehealth has realized the potential in the benefit of the patients.
These observations have been in the support of quality of health in ensuring a better
life apart from the clinical manifestations imparted. Moreover, the negative impact of the
quality of care is mainly due to the lack of knowledge among nurses and included health care
professional required in improvising the nature of implementations given. Increased
awareness about the improvement of diseases pertaining to a holistic approach and
amelioration of the quality of care given rather than the treatment given beyond mere clinical
therapies is pivotal. This will be helpful in increasing the quality of care given to patients in
the future.
Task4:
Among the various barriers for research evidence based practice, the main barriers are
knowledge, time, culture as well as support. Most of the times respondents has based
difficulties regarding limitation of time for proper research of evidence based practices which
is done during the scheduled working hours. Moreover, lack of proper knowledge has been
seen regarding understanding and finding the data as well as reports for using research reports
as well as data. Moreover, there has been inadequate support for clinical nurses which has to
bbe involved for research based practices. The lack of evidence further leads to reduced
confidence in nurses and their respective implementations in enhancing the care provided.
Furthermore, the lack of proper high quality research evidence alongside the reduced
awareness of influence of donors along with research as well as processes, with proper

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recognition of civil society organizations, low involvement further add to the difficulties
faced by the nurses in carrying out research work related to evidence based practices and
their proper implementation in the providing a pragmatic solution to the available disorders
(Hall and Rousel,2016). Apart from the aforementioned issues acting as potential barriers for
the treatment of patients suffering from nephrological ailments and undergoing
haemodialysis, the factors like size as well as complexity of the research along with very poor
access the various research based evidence and guidelines alongside ineffectual continuing
programs of educations also reduce the quality of care provided.
There are various strategies which can be implemented for preventing the effective
barriers of evidence based research often used in nursing practices. First and foremost an
effective timeline should be implemented highlighting the proposed schedule for completion
of all the requirements within time. Moreover structuring of the whole process is an effective
measure of time management thereby helping in the improvement of quality care. For the
difficulties experienced while development of the evidence based policy, implementations of
proper guidelines are necessary for the development of evidence based guidelines. There has
been many organisational barriers, so development of various strategies can be implemented
or increase in encouragement to the patients for following a proper healthcare advice. There
has been an increase in the information system which implemented properly can produce
various guidelines for effective management systems and their smooth processing.
There are many ways of implementing a pragmatic way of evidence based practice
approach in the aforementioned research setting, renal diseases or haemodialysis in this case.
First of all, implementation of mixed research methods like quantitative as well as qualitative
methods can help to gain a holistic approach and a more rounded understanding of the
required phenomenon which is mainly studied. This way the purposes of the study clubbed
with its advantages as well as disadvantages will be easier to implement and utilise in leading

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to a proper conclusion. Moreover, use of evidence based practices especially in domains
pertaining to nephrology in patients suffering from end state renal diseases undergoing
haemodialysis will help in improving the outcomes of the interaction as well as the cost
effectiveness and enhance patient’s satisfaction levels based on the available evidence. This
will help in providing a proper method of care in nursing practise enhancing the therapeutic
relationship between the patient and the nurse.

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References
Hall, H.R. and Roussel, L.A., 2016. Evidence-based practice. Jones & Bartlett Publishers.
Information, H., Statistics, H., States, K., States, K., Center, T. and Health, N. (2019). Kidney
Disease Statistics for the United States | NIDDK. [online] National Institute of Diabetes and
Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-
information/health-statistics/kidney-disease [Accessed 2 Feb. 2019].
Lunney, M., Lee, R., Tang, K., Wiebe, N., Bello, A.K., Thomas, C., Rabi, D., Tonelli, M. and
James, M.T., 2018. Impact of telehealth interventions on processes and quality of care for
patients with ESRD. American Journal of Kidney Diseases.
SuSeł, J., Batycka-Baran, A., Reich, A. and Szepietowski, J.C., 2014. Uraemic pruritus
markedly affects the quality of life and depressive symptoms in haemodialysis patients with
end-stage renal disease. Acta dermato-venereologica, 94(3), pp.276-281.
Tam-Tham, H. and Thomas, C.M., 2016. Does the evidence support conservative
management as an alternative to dialysis for older patients with advanced kidney disease?.