Friday, March 29, 2019
Chronic Kidney Disease
Chronic Kidney DiseaseChronic anatomys stimulate been defined as wellness problems that imply ongoing management everywhere a period of years or decades and redeem been labelled as the biggest challenge faced by the health sector in the twenty-first century (WHO, 200211). While the economic cost of managing them is high, Suhrcke, Fahey McKee (2008) find few fast economic arguments that whitethorn be made in support of the gather up for societies to invest in their (chronic affections) management. They identify some primary benefits such as improved health (in terms of patients quantity and character of breeding in years), long-term cost savings from complications that argon pr compensateted, and readyplace productivity see by patients and their employers. Management of such conditions ar no longer evaluated by the rates of survival alone further, in like manner, by the tint of life see by patients as a result of the therapy (Bowling, 2005)Chronic Kidney Disease ( CKD) is proper a global pandemic (Mahon, 2006 Chen, Scott, Mattern, Mohini Nissenson, 2006 Clements Ashurst, 2006). The infirmity ca applys gradual decline in kidney function (Silvestri, 2002). It has been categorised into 5 stages according to the glomerular filtration rates (Johnson Usherwood, 2005) and the attainment through these stages is influenced by several processes, roughlyly lifestyle-related (Riegersperger Sunder-Plassmann, 2007). Patients with stage 5 kidney disease (end stage) must receive kidney transplant, peritoneal dialysis or hemodialysis to survive (Niu Li, 2005). However, Wu et al. (2004) identifies that many patients undergo either haemodialysis or peritoneal dialysis because kidneys are, mostly, not gettable for transplant. Between these two treatment methods, haemodialysis is more plebeian in many countries (Jablonski, 2007 Zhang et al., 2007 Martchev, 2008) although Carmichael et al. (2000) report that roughly 50% of dialysis patients in the Un ited country are on some form of peritoneal dialysis.The two common treatment modalities for kidney sorrow (haemodialysis and peritoneal dialysis) encounter the same primary purposes to study metabolic waste and excess fluids, and maintain fluid and electrolyte balance the functions the kidneys have failed to perform (Martchev, 2008 Timmers et al, 2008). However, each of them places unique demands on the patient as strong as the healthcare team. For instance, patients on conventional haemodialysis have to cut down between three to four hours on the machine for three generation in a week (Rayment Bonner, 2007 Dunn, 1993). This, in addition to transportation to and from the haemodialysis centre or hospital, if they are not on home haemodialysis, affects their work or family life (Martchev, 2008). Likewise, patients on continuous ambulatory peritoneal dialysis (CAPD), the most common form of peritoneal dialysis, have to allow dialysate to dwell within their peritoneal cavity for an average of four hours and exchange of the dialysate is done about four snips in a day (Dunn, 1993 Bowman Martin, 1999 Gonzalez-Perez et al., 2005). Moreover, conformation to dialysis regimen is very difficult because of all the dietary and fluid restrictions and otherwise lifestyle modification associated with it (Cleary Drennan, 2005 Timmers et al., 2008 Martchev, 2008).Presently, more than 23,000 adults in the UK undergo dialysis treatment as a result of kidney failure and this number is expected to increase yearly (World Kidney Day, 2009). Korle-Bu Teaching Hospital (Ghana) recorded 558 cases of chronic kidney disease between January 2006 and July 2008 in the country (All Africa, 2009) and this may represent less than 30% of the total disease burden as the hospital serves a few regions in the country.I once encountered a 27-year old young man who had been diagnosed with kidney failure. At that oral sex in time, my concern was the kind of life he would experience depe nding on dialysis for survival. Cleary and Drennan (2005) identifies that patients with kidney failure have lower persona of life than the general sinewy population while Loos et al. (2003), also, identify that patients with kidney failure have poor step of life as compared to other patients with other chronic diseases. Complications such as anaemia and fatigue may contribute to the lower lineament of life in patients with kidney failure (Phillips, Davies White, 2001). Therefore, management of kidney failure should not only be cost-effective, but should also reserve acceptable quality of life for the patients (Kring Crane, 2009). How, then, behind health professionals provide an acceptable quality of life for persons diagnosed with kidney failure? major roles played by health care personnel include educating, encouraging, and assisting patients to exact the treatment modality that is best for their unique needs (Niu Li, 2005). It is, therefore, appropriate for nurses to endure which of the two kinds of treatment modalities promises an acceptable quality of life for individual patients, and this fellowship should be supported by appropriate evidence gathered through quality look for.In the 21st century, patients feelings and perceptions on health care are paramount to the feelings and perceptions of the health care providers (Bowling, 2005). Therefore, studying the quality of life, as experience by patients on a specific regimen, requires the direct, internal assessments of the patients and not the accusive assessment of the health care provider (Kring Crane, 2009). However, quality of life lacks a unanimous definition as a concept, making interpretation and entailment of studies on it very difficult (Cleary Drennan, 2005 Kring Crane, 2009). Researchers and theorists have reached a consensus on some characteristics of quality of life as a concept it is multidimensional, temporal and subjective (Bredow, Peterson Sandau, 2009). The multidim ensional aspect of the concept comprises of the physical, psychological and social capabilities of the person (McDowell, 1996 cited by Fortin et al., 2004). It is temporal because people fire change their values and perceptions to fix the changes in their perceived quality of life as circumstances change (Sprangers Schwartz, 1999). It is subjective because, as stated earlier, patients perceptions and feelings on such an outcome supersede that of the health care provider. Nevertheless, Tobita and Hyde (2007) states that there are some objective measures such as age and gender that rouse influence the measurement of quality of life. contrastive subjective tools have, therefore, been developed to measure subjective aspects of quality of life but these are of two kinds generic and disease-specific measures (Tobita Hyde, 2007). Generic tools measure broad aspects and can be apply for several types of diseases at different locations and for different ethnic groups while disease-spec ific tools are for specific types of diseases or patient groups (Patrick Deyo, 1989). When the two kinds of tools are combined, different populations can be compared and sensitivity to the changes that might occur with time is enhanced (Wu et al., 2004). The generic tool that is commonly used to measure quality of life is the Medical Outcomes Study Questionnaire 36-Item Short Form Health treasure (SF-36) (Neto et al., 2000 Fortin et al., 2004 Morsch, Gonalves Barros, 2006). Carmichael et al. (2000) identify that three disease-specific measures have been designed for dialysis patients and these are Kidney Disease Questionnaire (KDQ), a dubiousnessnaire designed by Parfrey et al. and the Kidney Disease Quality of Life questionnaire (KDQOL).Polaschek (2003) identifies that most of the studies that have been undertaken to explore the quality of life of patients with kidney failure have used the quantitative progress. However, he adds that a few nursing studies have used soft meth odologies in an attempt to actualise the quality of life as undergo by patients on dialysis. For example, Al-Arabi (2006) used the naturalistic enquiry method to identify how the challenges faced by patients with kidney failure influence their quality of life. Sadala and Loreon (2006) also used a phenomenological nest to explore patients perspective on their dependence on haemodialysis machines for survival. Grounded surmise onward motion has, also, been used Kaba et al. (2007) to understand patients experience of kidney failure and dialysis in Greece.So far, this essay has addressed the poorer quality of life experienced by patients with chronic conditions, with special emphasis on that of patients with kidney failure. It has, also, touched on the attempts made by theorists and researchers to conceptualise and assess quality of life. Development of tools to measure subjective quality of life has created more transmutation in the assessment of quality of life of patients, eith er by the use of quantitative or qualitative methodologies. It has been stated earlier that nurses and other health personnel assist patients in choosing the treatment modality that is best for their condition with the best available evidence. Therefore, the question for healthcare providers to answer is does peritoneal dialysis, compared to haemodialysis, provide a better quality of life for patients with kidney failure? The next sectionalisation would look at ways by which health care providers can use research to generate answers to the above question.This section would critically appraise various research methods that could be employed to answer my research question does peritoneal dialysis, compared to haemodialysis, provide a better quality of life for patients with kidney failure? Empirical research, audit/service evaluation and systematic review of produce studies are the approaches that would be considered in this essayEmpirical Researchqualitative and quantitative desig ns could be used to answer the above research question. However, step to control bias and to ensure reliability of the findings should be considered (Polit Cheryl, 2008). Consideration should also be given to ethical issues (Robson,..)Qualitative research is the best approach when questions on what, how and why on a phenomenon are to be answered (Green Thorogood, 2004). few of the research traditions that are used in qualitative studies include ethnography, phenomenology and grounded theory (Polit Cheryl, 2008). To understand quality of life, as experienced by dialysis patients from their own perspective, phenomenological approach appears to be more appropriate. Polit and Cheryl (2008) identify that phenomenological study focuses on the meaning and richness attached to a phenomenon by those experiencing it and suggest that this approach is beneficial for studies on concepts that have been poorly defined, such as quality of life.If phenomenological approach is used for my resea rch question, I would interview dialysis patients on how kidney failure and dialysis have bear on their quality of life, after obtaining their informed consent for the study. However, Ashworth (1996) states that researchers using descriptive phenomenological approach by Husserl should set aside all their preconceptions on the phenomenon that is being examine (bracketing). For instance, now that I know that dialysis patients have a poorer quality of life, as compared to other patients with other chronic diseases or the general healthy population, I should be able to set such an idea aside during the compendium and analysis of data. But Polit and Cheryl (2008) identify that researchers using interpretive phenomenology approach by Heideggar acknowledge that bracketing is not possible in empirical studies. Nevertheless, both types of phenomenological studies require the researcher to be open to all meanings that are given to a phenomenon by those experiencing it and maintain such an attitude when analysing the data and describing the findings.One terminus ad quem of phenomenology, however, is that small number of participants can be used for each typical phenomenological study, usually ten participants or less (Polit Cheryl, 2008). Phenomenology shares other limitations of qualitative research methods. Given (2006) identifies that qualitative research generate a lot of data, even when the sample size is small. He also states that collecting and analysing data may take a long time and results may not be generalised because of the small number of participants. Therefore, even though phenomenology and other qualitative methods may offer me rich and in-depth information on dialysis patients perspectives on their quality of life, a qualitative design may not be commensurate to answer this research question for generalisation purposes.