15_1_1
Volume 15, Number 1, pages 20 - 24
Development of a pamphlet: Introducing advance directives to hemodialysis patients and their families
By Judy Tigert, RN, MScN, CNCC(C), Nancy Chaloner, RN, BScN and Brenda Scarr, RN, BA, CNeph(C) and Kathy Webster, RN
Abstract
The proportion of patients starting renal replacement therapy who are elderly, dependent and have multiple co-morbidities is the fastest growing chronic kidney disease (CKD) population in Canada. Most professional nephrology organizations recommend that hemodialysis patients should be encouraged to write advance directives (AD). Advance directives or advance care planning (ACP) are terms that refer to instructions given by an individual that state his or her wishes for future medical treatment a n d personal care. AC P discussions occur infrequently between the hemodialysis patient and the health care team. Failure to initiate ACP discussions is often due to barriers such as comfort level, time constraints and lack of privacy. This paper reports the results of a small (n = 30) continuous quality improvement (CQI) initiative examining the effectiveness of developing and using a pamphlet to introduce the topic of AD with hemodialysis patients and their families.
In this study, it was found that many hemodialysis patients have thought about cardiopulmonary resuscitation (46.6%), mechanical ventilation (63.3%) and withdrawal of dialysis (56.6%). The majority of hemodialysis patients (70%) found that a pamphlet is helpful to introduce the topic of AD.
As a consequence of this CQI initiative, our renal program has further revised the pamphlet and is beginning to incorporate its use in patient care within the hemodialysis unit.
Author Affiliation(s): Judy Tigert, RN, MScN, CNCC(C), is a Nurse Practitioner/Clinical Nurse Specialist, London Health Sciences Centre, London, Ontario. Nancy Chaloner, RN, BScN, is a Staff Nurse, Hemodialysis Unit, London Health Sciences Centre, London, Ontario. Brenda Scarr, RN, BA, CNeph(C), is a Staff Nurse, Hemodialysis Unit, London Health Sciences Centre, London, Ontario. Kathy Webster, RN, is a Staff Nurse Hemodialysis Unit, London Health Sciences Centre, London, Ontario.