Nephrology is one of the specialized services offered and HD and CAPD are provided to patients. Most of the research undertaken on the renal population has been conducted by doctors or nurses. Based on the literature review, the researcher assumed that the voices of ESRD patients were unheard.
To understand the perceived similarities and differences regarding all of the above in HD and CAPD patients. Engel quoted in Schlebusch (1990:15) writes about the interaction of biological, psychological and social factors in all diseases. Treatment modalities, according to the biopsychosocial perspective, focus on the physical, psychological and socio-cultural aspects of the patient's life.
The social worker also stands at the interface of the family, the hospital-health care team, the community and society.
Types of kidney failure 20
Most people are born with two kidneys - one on each side of the spine just below the ribcage. Kidney failure is a term that means the kidneys are becoming less able than normal to perform their normal functions. Chronic kidney failure usually occurs over several years as the internal structures of the kidneys are slowly damaged.
Chronic renal failure and ESRD are reported to affect more than 2 in 1,000 people in the United States. Diabetes and hypertension (high blood pressure) are the two most common causes and are responsible for approximately two-thirds of cases of chronic renal failure and ESRD.
Symptoms 21
There may be no symptoms in the early stages and progression may be so gradual that symptoms do not appear until kidney function is less than one-tenth of normal. By the time end-stage kidney disease develops, kidneys are functioning at less than 10 to 15% of capacity. Dialysis is indicated when you develop end-stage renal failure; usually by the time you lose 85 to 90% of your kidney function (National Kidney Foundation: www.kidney.org).
Removes waste, salt and extra water to prevent them from building up in the body. In chronic or end-stage renal failure, the kidneys do not improve and dialysis is necessary until a new kidney is obtained.
Types of Dialysis 22
Blood is pumped from the patient's body to the artificial vein through a vascular access surgically created in the arm or leg. The patient's blood plasma travels across membranes inside the artificial kidney that filter out waste. Most patients require 12 hours of dialysis each week, usually divided into three sessions (Kidney failure, chronic: . www.mayoclinic.com).
A plastic tube called a catheter is surgically inserted into the patient's abdomen to make access. The difference is that the patient performs this type of dialysis at home, works and does it by exchanging the dialysis solution in the abdomen four times a day and these exchanges are spread throughout the day (Kidney failure, chronic: www.mayoclinic. com ).
Advantages and Disadvantages of HD and CAPD 23
For the purposes of this study, the researcher will refer to the types of therapy as renal replacement therapy (RRT). Because of the risk of infection and damage to the catheter, patients would be restricted from physical activities and active sports (Baxter 2006). Some patients are very self-conscious about the appearance of the catheter sticking out of the abdomen, or the pot-belly appearance caused by carrying two liters of fluid around all day.
People who have switched from HD to CAPD report that they feel much better psychologically because of the physiological benefits and the freedom of movement. Dialysis will be needed for the rest of the person's life, unless the patient undergoes successful transplant surgery.
Chronic Renal Failure in South Africa 25
Patients suffering from acute kidney failure that can be treated by kidney dialysis are automatically given access to kidney dialysis. However, patients who suffer from chronic kidney failure that is not reversible are not automatically admitted to the chronic kidney program. There are no restrictions of gender, race or social status. dialysis is offered to transplantable patients who are able to attend treatment.
Suffice it to say that the poorest of the poor living in a shack without water cannot be accepted into the chronic kidney program. Patients need to access dialysis closer to home, but the situation is challenging in the National Department of Health, as there are few state hospitals to care for RRT due to insufficient resources and staff, coupled with finances.
Quality of Life 27
Physical Functioning 27
- Diet and Fluid Restrictions 28
- Activities 29
Other aspects of stress in the treatment regimen than dietary and fluid restrictions provide the physical domain of quality of life. ESRD and its treatment cause major lifestyle changes for most patients, who experience frustration in all areas of life, including dietary and fluid intake restrictions. After the initial adjustment period, patients usually find that they can live comfortably with the diet.
The concept of adherence is increasingly used in place of medication adherence because it emphasizes an individual's active, informed cooperation with the treatment regimen. Tsay, cited in Shabalala (2004:42), reports that many ESRD patients have difficulty adhering to fluid restrictions, adding that they require major changes in lifestyle and self-efficacy to adhere to the treatment regimen of their chronic disease.
Psychological Functioning 30
- Uncertainty 30
- Fear of Death 30
- Body Image 31
- Dependence-Independence Issues 31
- Defense Mechanisms 32
- Treatment Nonadherence 34
He maintains that body image does not necessarily refer to the real body, as a dialysis machine or a phantom kidney can be experienced by the patient as an extension of the body. Patients experience altered taste and different odors than their breath due to the build-up in the body of wastes that are normally removed by the kidneys. Although the fistula is placed under the skin, they remain visible to the naked eye.
According to Baxter (2006), increased blood flow through the veins causes the backs of the palms and forearms to be puffy and raised, which is not cosmetically pleasing. When a fistula is located in the upper arm, blood flow to the hand and fingers is reduced, making it difficult or impossible to hold objects.
Social Functioning 35
- Work 35
- Family and Adaptation 36
- Sexuality Issues 37
- Social Isolation 38
The stress of being ill causes most patients to deteriorate psychologically, leaving the patient exhausted and leaving less energy available for family involvement. Even if family members are willing and able to provide assistance, the patient with ESRD with RRT may feel like he or she is a burden and refuse the help that is needed. Also disturbing symptoms such as swelling, feeling tired and weak can cause the patient to withdraw completely from family life.
This creates a situation with significant stress-related consequences for the family unit, especially when adaptation to the chronic renal program is not satisfactory. The level of marital and family functioning, including cohesion, conflict, communication, love, organization, and control, is a primary resource for the patient and is vulnerable to disruption as a result of illness and treatment. Therefore, ESRD and the introduction of treatment options can place an intolerable strain on families due to the need for levels of physical care and support, the emotional connotations of giving and receiving help, and changes in family roles and relationships, e.g. when the woman is forced to become the breadwinner.
Initially, a lot of energy is needed for the physical and emotional adaptation to the disease. Schlebusch (1990) and Galpin (1992) also emphasized the effect of change in body image on patient self-esteem. This affects the patient's sexual function as body image is intertwined with sexual identity and patterns of sexual functioning.
In men, depression, changing family roles due to job loss, and the impact of stopping urination (since the organ of urination is also the organ of sexuality) can contribute to sexual dysfunction. Galpin's (1992) study highlighted the effect of change in body image on patient self-esteem and the subsequent impact on sexual identity and sexual functioning patterns. In a study by Carl et al, cited in Hardy et al (1991), conducted on the psychological and social adjustment of CAPD and HD patients, findings revealed that CAPD patients do not have significantly superior adjustment compared to HD patients.
Cultural Influences 39
Health Education 39
It reduces uncertainty, helps the individual to come to terms with the disease and allows for the development of strategies for managing the disease in everyday life. Many ESRD patients and their families complain about the lack of information about the condition. Information on the Internet and the World Wide Web have made significant strides in increasing the availability of information to those with access to the appropriate technology.
It is possible that patients may misunderstand the complex information available on the Internet and therefore experience increased anxiety, false hope or a false sense of security. These issues are therefore best addressed by providing patients with as much information as they need so that they can gain a sense of control over their disease.
Socio-economic Factors 40
Religious Factors 41
Education 42
Poverty 42
Therefore, the discussion that follows will focus on the role of the social worker in nephrology. The validity and reliability of research results generally depend on the methodology used in the study. This study aimed to gain insight into patients' experiences of HD and CAPD in ESRD.
Therefore, the researcher was able to gain a greater understanding of the patient's knowledge and view of RRT as they experience it. Truth value: which asks whether the researcher has established confidence in the truth of the findings for the participants and the context in which the research is conducted. In this study, the researcher's social work skills and debriefing of participants were used to facilitate honest responses.
Every effort was made to be open and transparent with the participants about the role of the researcher, using neutrality during the interviews. ¾ The purpose of the research and the use of the material were explicitly told to the participants. Most of the participants were unemployed implying that this was probably due to illness and dialysis therapy.
The majority of participants were affected by a range of symptoms as indicated in the table below. The majority of the CAPD participants expressed that the risk of infection, peritonitis, was their worst fear. Overall, this study revealed that dialysis did not affect the strength of the patient-partner relationship.
This adjustment proved challenging for some participants and affected relationships with their partners (microsystemic influence). The ability to work and live a productive life is presented as having a significant impact on the lives of participants. The role of the nephrology social worker in optimizing treatment outcomes for patients with end-stage renal disease.
Fighting kidney disease in poor countries: building a global fund with the help of the pharmaceutical industry.
