The unexpected demise of a patient in the course of hemodialysis is an unusual happening. The occurrence of cardiac arrest in the course of dialysis is approximated to be seven people out of one-hundred thousand sessions of hemodialysis.
Out of the cases of cardiac arrests that emerge, about 13 per cent of them end up in deaths in the dialysis facility and 47 per cent pass away on their way to the hospital. The reason for death in most of these instances lies in cardiac arrhythmias, which is taken to be the main frequent cause (Booth, Pinney, & Davenport, 2010).
Cardiac arrest has as well occurred in the course of dialysis secondary to the unusual incidences of emboli, serious hemodialysis, and difficulties associated with improper dialysate handling. Pericardial effusions are common in patients undergoing hemodialysis.
However, they are normally associated with uremia or the utilization of minoxidil. The medical presentation handles the range from the establishment of resultant symptomless outburst on echocardiograph to cardiac tamponage with demise.
The first instance of deadly hemopericardium emanating from holes in the vena cava was accounted in 1981. Perforations in either the vena cava or atrium dextrum in the course of hemodialysis as witnessed in 1981 is an unusual source of cardiac tamponage.
This paper discusses the philosophy of nursing discipline associated with hemodialysis and cardiac issues.
Area of interest
Apparently, person-to-person or patient-centered care is related to the excellence of care. Significant research can make it possible for the nurses to learn and adapt patient-centered care. Research by Jablonski (2007) provides three important themes.
These themes are affiliation between the relations of patient with providers of medical care, organizations and their personal experience of disease and heath, the degree to which the organizations attempt to satisfy the requirements of patients, and integration of the views of the patients on the excellence of healthcare as offered by health care givers and devisers.
In his article, Jablonski evaluated the theoretical as well as experiential studies, examined the dimensions of patients having hemodialysis and efforts of doctors and nurses with respect to cardiac issues and quality of health care (Jablonski, 2007).
Research affirms that the relations between nurses and patients having hemodialysis are vital for successful use of patient-centered care. In accordance with these attempts, the area of interest for this paper investigates the practice of patient-centered care perception.
After the investigation, an explanation of its relevance follows the various constructs for realizing patient-centered care. From around 1970, different health care groups, strategy makers, and research groups have approved and held the concept of patient-centered care.
A number of studies define patient-centered care as the concern that reveres and acts in response to the needs of each patient while making sure that decisions by health care providers satisfy the ideals of patients.
Patient-centered care could have significant advantages for patients via enhanced relations, suitable involvement, increased satisfaction, and quality of the health care (Booth, Pinney, & Davenport, 2010).
Research has revealed that the greatest hindrance to successful execution of patient-centered care is the uncertainty of its designation and major constituents. Patient-centered care entails individualized care of patients anchored in particular information of each patient instead of concentrating solely on the illness.
Individualized care generates an inclusive healthcare advance where the doctor attempts to view the sickness through the point of view of the patient, and is quick to respond to the requirements and inclinations of the patient.
The perception of individualized care encompasses several subclasses like relations, admittance, and quality of health care (Booth, Pinney, & Davenport, 2010).
For minorities on hemodialysis and cardiac concerns, the execution of individualized care has as well brought about a reduction of period of stay, enhanced satisfaction of patients, and successful and excellent treatment that translates to reduced costs of health care.
From the point of view of nurses, through first-rate individualized care, health institutions are capable of creating a mark that retains its clients and gains reputation. Therefore, individualized care representation is progressively identified as significant for the assurance of excellent care (Booth, Pinney, & Davenport, 2010).
Even if many people consider that hospitals are set to satisfy the requirements of patients, there are significant chances to boost their individualized (person-to-person) care by offering medical care to each patient.
In a bid to operationalize the individualized care efficiently, hospitals should aspire to assist the characteristics of individualized care via teaching, collective information, incorporated and group management, and easy availability of important information.
This aspect stresses the requirement for critical adjustments in the health care structures by tackling or incorporating major issues like inequality in medical care, increased costs of health care, cardiac issues on patients having hemodialysis, and access to medical care.
Epistemological and ontological correspondence (worldviews)
Studies affirm that fibrosis with no necroinflammatory substance at the point of perforation indicates chronic trauma instead of infection-associated erosion because of recent cause of illness. The symptoms of cardiac tamponage encompass the following
- Epigastric ache
- Retrosternal ache
- Uneasiness (Jablonski, 2007, p.25).
The majority of difficulties encountered by people undergoing hemodialysis are linked to their lack of abidance by the treatment prescriptions. Moreover, unsuitable consumption of foods and too much fluid by the patients could bring about undesirable effects that rarify their situations.
For instance, they could encounter tremors due to failure to limit the intake of potassium. They could as well experience itching and bone aches due to unsuitable phosphate levels. In addition, too much intake of sodium and fluid could bring about undue weight increase.
Intake of too much sodium could lead to oedema particularly near the ankles, hypertension, and problems with breathing (Jablonski, 2007).
Additionally, excessive consumption of protein intensifies destruction of the kidney. Therefore, it is clear that abidance by the dietary and fluid limits will not just decrease the dangers of symptoms and health difficulties, but will as well better the quality of life of the patients.
Different studies have examined the extent to which patents going through dialysis comply with the prescriptions.
The results of the studies reveal substantial proof disclosing that excellent treatment with resulting kidney disease is directly associated with conformity, taking into account dietary restrictions, prescription given, and fluid limitation (Jablonski, 2007).
Nevertheless, there are researches showing that these patients fail to adhere to the prescribed diet and fluid intake and given medicines.
In essence, patients going through hemodialysis encounter disparate hardships in bearing with their status and normally ignore the requirement for a remedial diet. This scenario persists until the bad effects of lack of compliance arise and turn out to be intolerable.
When patients are accustomed to the effects of infringing dietary as well as fluid checks and when they deem the effects fatal, then there is a possibility that they will be extra mindful of their medical condition.
Since self-regard is a learnt conduct, knowledge and teaching are precious practices that can help patients to deal with their intricate medical prescriptions.
Nevertheless, when they are taught to comprehend the justification for their health prescriptions, as well as the causes and effects of their selections with regard to what they consume and drink, they are capable of coming up with wise judgments concerning whether or not to comply with the commendations.
Therefore, it appears that lack of knowledge is the greatest aspect leading to non-adherence with the medical prescriptions (Booth, Pinney, & Davenport, 2010). The prescriptions are particularly fluid and food limitations that consequently may cause worsening of the sickness.
The necessity of sufficient teaching and learning programs concerning medical prescriptions, specifically with a focus on fluid and food prescriptions for patients taking hemodialysis, has been under discourse in different nursing studies.
Nevertheless, the incongruence involving different kinds of educational techniques and their efficiency on food and fluid adherence requires further evaluation.
Oral education encompassing a person-to-person patient education in the company of a nephrology nurse is among the techniques employed for educating patients that undergo hemodialysis. Oral teaching via group education program is just as efficient as person-to-person education (Booth, Pinney, & Davenport, 2010).
Moreover, patients have declared that group teaching is very helpful in directing them for suitable self-care.
Nonetheless, a number of researchers consider that patient teaching via oral teaching programs is normally concise and do not offer a sufficient information basis, while video teaching could have a number of merits and carry out a significant task in the education process.
It is clear that the application of video creates a more consequential teaching substance. Through the pictorial illustration to patients on the way they should eat and drink and other knowledge applicable to self-care, it could be anticipated that patients can keep hold of this information in a better way.
More to the incongruence, there is no research that has been conducted to examine the contribution of video teaching for patients that have chronic health situations particularly with regard to renal illnesses and resulting cardiac issues for those having hemodialysis.
The majority of past assessments were for surgical pre-adjustment or teaching after surgery, rape, self-assessment or prevention of sexually transmitted diseases.
In this regard, it is crucial that future research study the effects of video teaching on food and fluid adherence in patients that have taken hemodialysis (Booth, Pinney, & Davenport, 2010).
Instances from studies
Adjustable risk factors connected with cardiac arrest for patients having hemodialysis
Sudden cardiac arrest denotes the most usual reason for death of patients taking hemodialysis. Although the patient is capable of being saved after the sudden cardiac arrest, there is very little possibility of lasting survival.
Therefore, the major challenge in dealing with patients having end-stage kidney disease (ESKD) and that need hemodialysis is the way to offer a life-sustaining health care while decreasing the risk experience for sudden cardiac arrest (SCA).
The best advance to this difficulty is to identify the status of patients with severe chronic kidney illness and that are specifically susceptible to sudden cardiac arrest. Research affirms that merely a decrease of glomerular filtration rate adds onto the risk of sudden cardiac arrest.
Nevertheless, it is clear that experience of hemodialysis as well increases the risk (Booth, Pinney, & Davenport, 2010).
Definitely, a greater chance of cardiac risk aspects like age, diabetes, and heart diseases amid patients having chronic kidney disease (CKD) is seen amid patients having chronic kidney disease; however, if these aspects predict sudden cardiac arrest during hemodialysis is not yet comprehensible.
A section of the unfavorable effects of hemodialysis possibly emanates from non-physiological character of fast drink and electrolyte swings that arise in the course of a hemodialysis session (Green et al., 2011).
In reality, epidemiological studies stress that the risk of sudden cardiac arrest is increased during hemodialysis and a noteworthy fraction of all instances of sudden cardiac arrest arise in the hemodialysis clinics.
In spite of this proof, it is not clear as to whether the rise in the risk of sudden cardiac arrest is due to adjustable dialysis- explicit aspects or to the worsening of a cardiac issue.
Acute cardiac issues in hemodialysis in cases of no previous cardiac sign
Cardiac issues brought about by coronary artery disease signify a key reason behind death in patients having CKD taking hemodialysis.
Jefferies et al. (2011) illustrated this model in their research by suggesting that coronary artery disease was higher in people having lasting sustenance hemodialysis, since coronary artery disease was evident in the majority of patients without previous signs of cardiac issues prior to start of hemodialysis.
In fact, cardiac issues and deaths arise with a higher incidence in lasting sustenance hemodialysis (Jefferies et al., 2011). In different researches, long-term incidences of hemodialysis were not related to an augment in the risk of mortality rate cardiac issues.
Additionally, acute myocardial infarction was highly probable to arise in a short instance after the start of hemodialysis as compared to an extended instance of hemodialysis.
The aforementioned outcomes propose that cardiac issues are highly developed and the possibility of death from cardiac issues is already high prior to having hemodialysis that could seem improbable in it to worsen cardiac issues (Jefferies et al., 2011).
The aforementioned concern can be dealt with through the determination of the incidence rate of an early Major Adverse Cardiac Event (MACE).
MACE is powerfully linked to coronary artery disease and the incidences of deaths because of cardiac issues in new patients having hemodialysis and lacking both cardiac signs and any proof of insufficient cardiac function in the course of chronic kidney disease.
Since the screening for coronary artery disease is not normally conducted at the start of hemodialysis, the baseline for coronary artery disease and other aspects was evaluated between patients with and without subsequent cardiac issues happening after the start of hemodialysis.
Educational involvements through either oral or video teaching could have an influence on the food and fluid compliance of the patient.
The significance of compliance is highlighted in studies, which affirm that the excellent medical treatments are of no value if a patient decides not to abide by the directions of the health care providers. Conventionally, there is no particular structure or principle for assessing adherence to the hemodialysis therapy as directed.
Currently, adherence is described by different considerations like failure to attend a hemodialysis session, individualized care, and serum electrolytes. It has been found out that many adherence measures are likened to results of the acre to the patient.
There are emphases that adherence measures must be quantifiable, confirmable, and perfect (Wanek et al., 2012). In essence, adherence measures must be significant for patients having hemodialysis and the cause of the disease must be isolated from other aspects and be associated with the significant outcomes.
Consequently, fluid and food adherence is normally settled on by evaluating serum electrolytes among other factors. The results got from some research demonstrate that the majority of patients were acquiescent with regard to calcium, potassium, weight increase just to mention a few.
The outcomes of compliance were significant since many patients are believed to have trouble in managing their sodium intake and salt being a key constituent of the majority of foods, thus suggesting little salt intake does not augur well with patients.
The relationship between weight increase and activity shows that patients that spend their entire days while working as well as the ones carrying out part-time activities experienced hardships in managing their weight between hemodialysis sessions.
This observation shows that employed patients find it hard to adhere to their nutritional prescriptions. The foods they often take contain high levels sodium thus causing them to feel thirsty and as a result take large volumes of fluids (Barnett et al., 2008).
There are as well indications that education levels are related to the adherence of patients with the prescriptions. Nevertheless, some studies suggest that there is no correlation between education and adherence.
As earlier stated, high levels of potassium intake could bring about instant and fatal consequences like cardiac arrest and high death rate. Therefore, patients should be more conscious and keen to control their intake of potassium.
Contrary to potassium, high levels of phosphate can lead to severe consequences like bone illnesses with patients will realize these effects just after living with it for a long time (Barnett et al., 2008). Hence, patients have a tendency of believing that the effects are less noteworthy and less frightening.
Even though it is reported that video teaching provides more benefits as compared to oral teaching, video teaching does not offer adequate depiction to permit a superb conclusion with respect to calcium.
In this paper, benefits of individualized care, the results of two education programs on food and fluid adherence in patients taking hemodialysis, and arising of cardiac issues have been discussed. In this study, the lasting consequences of oral teaching against video teaching on the results were not adequately discussed.
In addition, the effect of patient counseling on their understanding was not examined, and this element should be discussed in future studies.
Moreover, it should be discussed in details to highlight the association between understanding of information and other health results, in addition to various features of oral and video teaching and the excellence of hemodialysis care.
Finally, quality of existence in patients that have undertaken hemodialysis and its relationship with teaching involvements is another key concern that future studies will need to address (Albert, Buchsbaum, & Li, 2007).
Effective treatment of patients with end-stage kidney disease necessitates the adherence of patients with intricate and fundamentally significant medical prescriptions. Research states that the relationship between nurses and patients taking hemodialysis are imperative for successful exploit of patient-centered care.
The area of attention for this paper considers the practice of individualized care. After the examination, an elucidation of its application follows the diverse constructs for realizing individualized care.
Enhancing the understanding of information of patients taking hemodialysis should be an essential section of treatment. It is fundamental that nurses highlight adherence with sodium intake to prevent the severe consequences like hypertension, weight increase, and oedema.
Albert, N., Buchsbaum, R., & Li, J. (2007). Randomized study of the effect of video education on heart failure healthcare utilization, symptoms, and self-care behaviors. Patient Education and Counseling, 69(1), 129–139.
Barnett, T., Li Yoong, T., Pinikahana J., & Si-Yen, T. (2008). Fluid compliance among patients having haemodialysis: can an educational program make a difference? Journal of Advanced Nursing, 61, 300–306.
Booth, J., Pinney, J., & Davenport, A. (2010). N-terminal proBNP—marker of cardiac dysfunction, fluid overload, or malnutrition in hemodialysis patients. Clinical Journal of the American Society of Nephrology, 5(6), 1026-1040.
Green, D., Roberts, R., New, I., & Kalra, A. (2011). Sudden cardiac death in hemodialysis patients: an in-depth review. American Journal of Kidney Diseases, 57(6), 921-929.
Jablonski, A. (2007). The multidimensional characteristics of symptoms reported by patients on hemodialysis. Nephrology Nursing Journal, 34(1), 22-29.
Jefferies, H., Virk, B., Schiller, B., Moran, J., & McIntyre, C. W. (2011). Frequent hemodialysis schedules are associated with reduced levels of dialysis-induced cardiac injury (myocardial stunning). Clinical Journal of the American Society of Nephrology, 6(6), 1326-1332.
Wanek, R., Horn, E., Elapavaluru, S., Baroody, C., & Sokos, G. (2012). Safe use of hemodialysis for dabigatran removal before cardiac surgery. The Annals of Pharmacotherapy, 46(9), 21-25.