Development of Renal Palliative Care for End Stage Renal Disease with Denial Renal Replacement Therapy in Yala Hospital

Abstract

This action research aimed to 1) study situation, 2) develop model, and 3) evaluate outcomes of care model. 3 phases were implemented. Phase 1: study of  situation included focus group which had 3 groups of sample including 1) patients, 2) relatives, 3) multidisciplinary care team, with a total of 19 persons and structured interviewing form which had IOC ranging from .66-1.00 was used. Phase 2: Development of model care was implemented by using study results of phase 1 and literature review and care model was drafted and validated by a panel of 3 experts. Phase 3: Evaluation of outcomes of development of care model consisted of 2 groups of sample including 1) 8 patients with end stage  renal disease with denial renal replacement therapy which were purposively selected, 2) 42 nurses who had experience in caring for 8 patients with end stage  renal disease which were purposively selected. Research instruments were questionnaire of satisfaction on palliative care, home visit, and opinion of multidisciplinary care team which had IOC ranging from .67-1.00 and Cronbach alpha coefficient reliability of .742, .732, .802. Data were analyzed using descriptive statistics including frequency, percentage, and standard deviation.  Results were revealed as follows;

            1). Situation of of renal palliative care for end stage renal disease with denial renal replacement therapy in Yala hospital had 2 aspects of care problem including 1) aspect of patients including 1.1) fear of hemodialysis and religious belief, 1.2) family burden, 1.3) need for palliative care, 2) aspect of  multidisciplinary care team including 2.1 ) early care planning, 2.2) patients home visit, 2.3) management of uncomfortable  symptoms, 2.4) knowledge development and supervision.

            2).  Model of renal palliative care for end stage renal disease with denial renal replacement therapy in Yala hospital consisted of caring for patients from screening, caring in hospital, continuous care at home which was a care model from hospital to home until patients death.

            3)  After development of a model, it was found that satisfaction of patients and/or primary care givers towards  palliative care was 88%, satisfaction of patients and/or primary care givers towards home visit 91%, Opinion of service team on a care model, overall, was at the highest level (x̄ = 4.45 ;SD= 0.57). For indicative outcomes, it was found that rate of preparation of advance care plan for patients and families was 100%, rate of continuous care for patients was 100%, rate of appropriate symptom management for patients was 100%.

            Therefore, nursing practice guideline should be extended to a network of community hospitals  in Yala province and areas of three southernmost provinces because a model had the same contextual care which was  a developed model from hospital to community and was continuous care.